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RECEIVED <br /> OCT 18 2018 <br /> CERTIFICATE OF DISPOSAURECYCLING ENVIRONMENTAL. <br /> HEALTH DEPARTMENT <br /> San Joaquin County Regional Household Hazardous Waste Program <br /> San Joaquin County Household Hazardous Waste Facility <br /> 7850 South R.A Bridgeford Street, Stockton, CA 95206 <br /> Administrative Office: (209),468-3066 <br /> Customer Information <br /> Name(print) Date <br /> Street Address <br /> Cith <br /> j/State/Zip Code Area Code&Telephone Number <br /> 4 declare,underpenafty of pegury!Mat ft waste I <br /> bioaW la lids faddy was gerverated by a fesident and <br /> was not generated by a business. vu?- <br /> Material-Received QuanfMr (10 t 90). <br /> [P*F1r0cqsse4 <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> To be ouroeted by HHVV Fadfity Staff Member <br /> Certification Statement: <br /> The San Joaquin County Household HazaFdous Waste Facility Certifies acceptance of the <br /> material referenced on this document. The material has been managed in accordance <br /> with United States Environmental Protection Agency and State of California Environmental <br /> Protection Agency waste management regulations. <br /> t--�Staff Member Signature: 6 <br /> Staff Member Name(print): <br /> 1 <br /> Environmental Health Referral*. �Y• N <br /> L/ehide License Plate Number(if applicable): <br />